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Bronchiolitis Obliterans Post-HSCT — RACP Paediatrics MCQ

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HardRespiratoryBronchiolitis Obliterans Post-HSCTRACP Paediatrics

A 6-year-old child post bone marrow transplant develops progressive cough and dyspnoea. Spirometry shows a fixed obstructive pattern (FEV1 35% predicted) that does not respond to bronchodilators. HRCT shows air trapping and bronchial wall thickening. What is the diagnosis?

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Correct answer: C — Bronchiolitis obliterans syndrome (obliterative bronchiolitis)

Bronchiolitis obliterans syndrome (BOS) is a form of chronic graft-versus-host disease affecting the lungs after HSCT. It presents with progressive fixed airflow obstruction on spirometry and air trapping on HRCT. Prognosis is poor. Treatment includes systemic immunosuppression and azithromycin.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Post-HSCT Pulmonary Complications